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Why Americans have grown more hesitant about the COVID-19 vaccine

The best vaccines are only as effective as people’s willingness to take them, and amid the global pandemic, American confidence in a COVID-19 vaccine is shrinking before one is even available.

Facing a virus that has already sickened millions of people around the globe — including the president of the United States — and killed above a million more, public health experts regard a vaccine as the one thing that can help the planet regain control and restore a semblance of normality.

But the number of U.S. adults who say they would get vaccinated against COVID-19 has slipped significantly since August, when 60 percent of people surveyed in a PBS NewsHour/NPR/Marist poll were willing. On Sept. 18, just 49 percent of Americans said they would get vaccinated against COVID-19, while another 44 percent said they would not.

Since the early days of the pandemic’s arrival in the U.S., the Trump administration has taken several steps that made the American public question how much sway politics may have over science and health. And at this point, polarizing U.S. politics are fueling division over vaccines, public health experts say.

Chart by Megan McGrew/PBS NewsHour

Malcom Lowry, a respiratory therapist in Melrose, Florida, said he won’t get vaccinated. He thinks news reports about the virus are overblown to erode trust in President Donald Trump’s ability to lead.

“It’s all about fear-mongering,” said Lowry, a 58-year-old Republican.

Even after Trump was diagnosed with COVID-19, Lowry maintained that he doesn’t want to be given the vaccine, based on the vetting process so far for those currently in development.

Christopher Zamora, a 24-year-old college student who attends Arizona State University, said getting vaccinated is “the smart thing to do.” The virus has already touched his family directly (his brother caught it while in jail) and indirectly (several family members lost jobs or wages due to the COVID-19 recession), he said.

“I trust the science,” Zamora, a Democrat, said.

Around the globe, “Sentiments seeding doubt and distrust and the viral spread of misinformation are contributing to a landscape of uncertainty,” five researchers who study vaccine perceptions wrote in The Lancet last month.

Democratic vice presidential nominee Sen. Kamala Harris was asked in Wednesday’s debate if she would take a COVID-19 vaccine that was approved by the Trump administration. “If the public health professionals, if Dr. Fauci, if the doctors tell us that we should take it, I’ll be the first in line to take it. Absolutely,” she said, referring to the director of the National Institute of Allergy and Infectious Diseases. “But if Donald Trump tells us that we should take it, I’m not taking it.”

Her rival, Vice President Mike Pence, accused her of undermining confidence in the vaccine. But September’s NewsHour/NPR/Marist poll found that 52 percent of Americans think that Democratic presidential nominee Joe Biden would do a better job managing the pandemic, compared to 39 percent who favored President Donald Trump.

The PBS NewsHour asked experts what’s at stake as researchers work on developing vaccine candidates, and what can restore people’s confidence in public health and science.

How we got here

For years, anti-vaccine sentiments have gnawed at the fringes of American attitudes about immunization and public health, and in some pockets of the country, undermined confidence in vaccines to stop the spread of infectious diseases, manifesting in outbreaks. In 2018, a measles outbreak in New York City put thousands of children at risk of potentially lethal infection and hundreds of kids got sick, most of whom were not vaccinated for this entirely preventable childhood illness.

At the onset of COVID-19, no humans were immune to this virus, meaning a vaccine was and remains critical. But a lot of talking points embraced by the anti-vaccine community — such as false links to debilitating disorders, or overall ineffectiveness — “have been appropriated for this virus,” said Dr. Angela Rasmussen, a virologist who studies infection and immunity at Columbia University’s Mailman School of Public Health. As a result, more people think “that science is not credible,” she said.

The Trump administration committed to making “300 million doses of safe and effective vaccines”available by January 2021 through Operation Warp Speed — a name that rubs some public health experts the wrong way, said Lawrence Gostin, who directs the O’Neill Institute for National and Global Health Law and the World Health Organization Collaborating Center on National & Global Health Law at Georgetown Law. Developing a vaccine is a staid process driven by the scientific method and rigorous clinical trials, and “warp speed” could imply recklessness, he said, adding that Trump has signaled to the public that “he’s in a rush to get a vaccine,” which is problematic.

On Sept. 16, Trump said during a White House press briefing that the U.S. vaccine distribution may “start some time in October.” Public health officials have repeatedly knocked down that suggestion, saying next year was more likely. During the Oct. 7 vice presidential debate, Vice President Mike Pence said that under Trump’s leadership, they believe they “will have literally tens of millions of doses of a vaccine before the end of this year.”

But even then, there are questions about how many people would be able to get the vaccine, who would get priority and how quickly enough people — between 60 and 70 percent of the population — would be inoculated to regain control over the virus.

“That leaves the public to think that the process for approval has as much to do with electoral politics as it does with science and regulatory review,” Gostin said. And it’s far from the only instance that has raised doubt.

The Food and Drug Administration issued industry requirements in June for a COVID-19 vaccine that would have meant that it would likely not be ready for use by the public by Election Day. This week, the White House tried to block the rules, but reversed its stance on Tuesday. By Wednesday, the FDA issued a clarifying statement to remind the public of the agency’s “science-based decision-making process that assures vaccine quality, safety and efficacy for any vaccine,” according to Peter Marks, who directs the FDA’s Center for Biologics Evaluation and Research in a released statement.

“”Being open and clear about the circumstances under which the issuance of an emergency use authorization for a COVID-19 vaccine would be appropriate is critical to building public confidence and ensuring the use of COVID-19 vaccines once available,” Marks said.

Science versus politics

Those moves have scared and confused people who would normally support vaccination, Rasmussen said.

“People don’t know what to think,” she said. “They don’t know if it’s going to be reliable or not.”

In the Sept. 10 Lancet article, the authors affiliated with the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine surveyed more than 284,000 people in 149 countries between 2015 and 2019. They asked three simple but fundamental questions: Are vaccines safe? Are vaccines important? Are vaccines effective?

While most Americans said vaccines are important, roughly half said they were safe and slightly more said they were effective. This is no accident, the study authors said, pointing to voices who “have purposefully polarised vaccine debates, exploiting the doubting public and system weaknesses for political purposes.” They added that broader distrust of government officials and scientists could drive down vaccine confidence.

Heidi Larson, an anthropologist who founded and directs the Vaccine Confidence Project, said that more than a decade of research had found that Europe, and particularly France, has emerged as the global epicenter for vaccine skepticism.

Looking at the United States, she said it is hard to compare the nation as a whole to other countries because there are such wide-ranging opinions depending on which state or even which community you find yourself. Instead, Larson said, if one were to explore vaccine attitudes at the state level in the U.S., they would find that, “some states would look more like France and others like Finland,” where vaccine confidence is particularly strong.

When her team studies social media and traces the origins of messages that sow doubt about vaccines, Larson said highly organized and well-funded groups and individuals in the U.S. often are to blame. These actors amplify the negatives as much as the positives, she said, and they appear driven by a desire “to disrupt societies and divide them,” rather than genuine concern about vaccine safety and efficacy.

“The U.S. is the absolute fountain of the worst of anti-vaccine sentiments,” she said. “It travels all over the world.”

Getting back to normal

Weeks before President Donald Trump and more than a dozen White House aides or political allies tested positive for the coronavirus, he expressed optimism to reporters that the nation was “rounding the corner” on the pandemic.

But most Americans did not share that view. In the PBS NewsHour/NPR/Marist poll conducted the same week, 69 percent of Americans said it will be six months or more before daily life returns to normal. That includes 29 percent who say it’ll be a year before life gets back to normal, and another 20 percent who say it’ll take even longer than that. It’s a feeling echoed by several of the nation’s leading scientists, including Dr. Anthony Fauci, who has said, logistically, enough people in the U.S. would not be inoculated against COVID-19 until the latter half of 2021.

Chart by Megan McGrew/PBS NewsHour

For a nation trying to reopen public life, including schools, rebuild its economy and make hugs safe again, a safe and effective vaccine is part of the equation. And “the right kind of information and dialogue” can help people who are vaccine hesitant understand what’s at stake, said Dr. Ruth Karron, who directs the Center for Immunization Research at Johns Hopkins University.

Karron sees emerging reluctance as a teaching opportunity about the process of clinical trials. Larson also said she was taken aback by how little the public knew about the process that produces vaccines, which she called “a failure on the part of the scientific community,” and echoed that scientists need to do a better job of explaining that process so that people can understand it.

When AstraZeneca announced that one person participating in a clinical trial became ill, it’s a signal to researchers that they need to pause and see if the vaccine caused the illness or if the patient’s sickness was brought on by something else, Karron said. But such an incident doesn’t mean the vaccine is being rushed, or that it is unsafe or will fail. Vaccine development is progressing relatively quickly because of the enormous “resources that have been brought to bear,” she said.

“Given the nature of the pandemic, we need rapid progress,” Karron said. “That’s going to be our way out of this incredible problem and tragedy before us.”

After Ebola, Larson said, the global community realized it needed a funding mechanism to more quickly develop vaccine candidates in response to a disease outbreak. In 2017, the Bill and Melinda Gates Foundation, the Wellcome Trust and multiple nations, including Norway, India and Japan, established the Coalition for Epidemic Preparedness Innovations to ensure money could move quickly to pay for vaccine development and manufacturing to thwart a pandemic. Those funds allowed researchers to take advantage of newer technologies, giving humanity a competitive edge against a rapidly multiplying virus, Larson said.

“There’s tech available for the COVID vaccines that was not available for the old ones,” she said. “It’s not like we’re taking old technologies and short-cutting it.”

As researchers work toward standing up a vaccine, transparency and sharing data with the public is just as vital as preventing politics from interfering with the scientific process, said Dr. Eric Topol, a cardiologist, scientist and author who founded and directs the Scripps Research Translational Institute.

Although the pandemic’s toll is bleak, the situation is not beyond hope, Topol said. But it does require urgent action. Science, not politics, must lead the American response to the virus, he said. That ethos has already helped other countries, such as New Zealand and Japan, regain control over the virus and respond more effectively when outbreaks are identified.

Despite growing evidence that wearing a face mask helps prevent COVID-19 from spreading, people are still questioning their value, he said. Masks, too, have suffered from widespread misinformation, inconsistent public health messaging, and political leaders who continue to undermine their importance. If the public has no faith in something so low-tech as a few pieces of cloth to shield themselves and others against the spray of infectious respiratory droplets, he said, how can one expect them to be on board with a far more sophisticated public health tool, such as a vaccine?

More fundamentally, people need to be willing to help each other, Topol said, who said that altruism in the U.S. has come unraveled but is not a lost cause.

“We’re in this together, and we want to get out of this together,” he said.